SoCal Intake Form

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SoCal Holistic Health Membership Agreement Pursuant to California Health and Safety Code § 11362.775 I hereby certify that I am a qualified patient suffering from serious medical conditions and I have obtained a recommendation or approval from a licensed physician in the State of California to use medical cannabis (marijuana) to treat my medical conditions. A copy of my recommendation, as well as other personal information, may be attached hereto.

As a qualified medical marijuana patient under California law, I choose to associate in order collectively or cooperatively to cultivate marijuana for medical purposes. I understand that all members of SoCal Holistic Health (Collective) will contribute labor, funds, and/or materials, and all will receive medicine. I join this collective in accordance with California Health and Safety Code § 11362.775, which states:

Qualified patients, persons with valid identification cards, and the designated primary caregivers of qualified patients and persons with valid identification cards, who associate within the State of California in order collectively or cooperatively to cultivate marijuana for medical purposes, shall not solely on the basis of that fact be subject to state criminal sanctions under Section 11357, 11358, 11359, 11360, 11366, 1366.5, or 11570.

According to California law, patients may cultivate 6 mature or 12 immature plants, and possess up to 8 ounces of dried cannabis flower/bud. If those amounts are not sufficient for a patient’s medical needs, a patient may possess an amount of marijuana reasonably related to their personal medical needs. I authorize and assign to SoCal Holistic Health the ability to possess, transport, cultivate, and store at least 6 mature or 12 immature plants and eight ounces of dried flower/bud, and if those amounts are not sufficient, an amount of marijuana reasonably related to my personal medical needs. I further authorize SoCal Holistic Health to distribute a portion of this medical cannabis to other members of the collective.

According to the "August 2008 Guidelines for the Security and Non-Diversion of Marijuana Grown for Medical Use" by California Attorney General Edmund G. Brown Jr., collectives and cooperatives may cultivate and transport marijuana in aggregate amounts tied to its membership numbers. Any patient or primary caregiver exceeding individual possession guidelines should have supporting records readily available when: 1) Operating a location for cultivation; 2) Transporting the group’s medical marijuana; and 3) Operating a location for distribution to members of the collective or cooperative.

I hereby declare that I will not distribute medicine received from the Collective to any other person, and that I shall use medicine received from the Collective for medicinal purposes only. This agreement shall be in effect as of today.

I have read and agree to the terms and conditions outlined in SoCal Holistic Health Membership Agreement. I certify under the penalty of perjury that the statements made are true and that I am not seeking membership for any fraudulent or illegal purpose.